So you're GBS+, Now What? Tips for a healthy labor and a healthy baby by Lisa Porter

Remember, I'm not a doctor or a lawyer...ask your birth professional for more information and educate yourself about the issues. Decide for yourself if this information is reasonable for your situation.

Tips for GBS+ moms: Hints for having a healthy labor and a healthy baby. (These suggestions are generally geared toward moms WITHOUT a history of GBS complications, but they seem to be reasonable for most GBS moms who had complications in past pregnancies, too.)

1) None of the GBS prevention protocols recommend inducing labor in term GBS+ moms to control labor and get "enough" antibiotics.

If you are term (37 or more weeks) and haven't had any risk factors (fever in labor, prolonged rupture of membranes, etc.) the

antibiotics begin to be effective against GBS very quickly. Two doses of antibiotics (or more) before birth are recommended as a *guideline* for doctors. Once two doses have been given, most (95%+) of the GBS have been eliminated from mom's system. When you start the antibiotics they begin to kill off the GBS, but doctors want you to get at least two doses before delivery so they know the bacteria are gone before baby comes through the birth canal. This DOESN'T mean that the recommendation calls for induction to get that amount of antibiotics!

"Four hours of antibiotics" are recommended because the second dose is often given 4 hours after the first dose. Get the antibiotics as soon as it's reasonable to get do so, but remember: national medical recommendations DO NOT suggest inducing labor just to get two or more doses of antibiotics before birth.

If you're concerned about a fast labor, be reassured -- a natural non-induced) fast labor means baby comes into contact with the bacteria for a shorter amount of time.

2) Avoid "routine" internal fetal monitoring in labor.

The internal probe creates a small scrape on baby's head where the bacteria can get into baby's bloodstream.

Talk with your provider about the risks and benefits of using the internal monitor. If you and the doctor decide that it's absolutely necessary, try to make sure you've had IV antibiotics for a reasonable period of time before the internal monitor is used.

The more often you put something (hands, monitors, etc.) in the vagina, the more you push the bacteria toward baby. It appears that GBS lives near the entrance of the vagina in most cases -- don't push it toward the cervix by getting

unnecessary cervical checks. Research indicates that having more than 6 internal exams/cervical checks is a risk factor for infection. In general, the fewer cervical checks, the better.

4) Don't agree to let the provider rupture membranes to induce labor.

The membranes are a barrier between baby and the bacteria, and rupturing them allows GBS to have access to baby. It also puts you on a schedule for delivery and increases the chance of

prolonged rupture of membranes (a risk factor) as well as c-section. Rupturing membranes late in labor -- AFTER the IV antibiotics are started -- does not seem to be as problematic.

5) Talk to your OB/midwife about her prevention strategy.

Your provider should plan to start IV penicillin (it's recommended over ampicillin because there's less risk of affecting other, healthy bacteria) or clindamycin/erythromycin (if allergic to penicillin) when you're admitted and continue it until delivery.

You can have a heparin or saline "locked" IV if your goal is an unmedicated birth. With a locked IV, the antibiotics can be given in just a few minutes every four hours and the rest of the time you can move around as you choose.

Remember, the antibiotics are given to you to *protect baby.* IVs in labor aren't fun, but the they can prevent infection in baby, so they're worth consideration.

If you're birthing at home or at a birthing center, ask if the midwife can give IV antibiotics during labor. Find out what they'll do if you develop risk factors. Be sure to read the information about minimizing the risk of infection to make a fully informed choice about preventing GBS in your chosen birth place.

6) Antibiotics BEFORE labor are not recommended EXCEPT for treatment of GBS in the urine.

Taking

oral antibiotics BEFORE labor to get rid of vaginal/rectal GBS colonization (as opposed to urinary tract infection) will not reduce the risk of infection for baby, but it *will* mean that you're using antibiotics unnecessarily. Antibiotics should ONLY be used to treat when they're targeted to prevent infection (like during labor) or cure infection (GBS in the urine, for example.)

Treating before labor does NOT prevent infection in a low-risk GBS+ moms because in most cases, GBS will come right back after treatment stops. Moms with GBS in the urine NEED the antibiotics b/c they have an infection. Moms who have GBS only in the vagina or intestines are not infected and should wait for labor to be treated with antibiotics.

IV antibiotics in labor are the only proven way to protect baby from early onset GBS infection. They work when baby is at the highest risk of encountering the bacteria - during labor and delivery.

7) Consider a URINE screen for GBS during late pregnancy.

GBS in the urine indicates a higher risk of infection in baby since it correlates with high levels of GBS in the vagina. GBS urinary tract infections (u.t.i.s) are often asymptomatic (without symptoms), so you might not know it's there. Testing the urine for GBS is the only way to know if GBS is present.

GBS in the urine has been linked to preterm labor/delivery and premature rupture of membranes. It is very important to get rid of GBS in the urine immediately. It does not matter how *many* GBS are found --GBS in the urine requires oral antibiotics when it's diagnosed. The CDC recommendations are clear on this point.

If you develop preterm labor, ask for a urine culture and vaginal/rectal GBS culture to be sure GBS isn't a problem. A urine culture for GBS may also be a reasonable idea if you've had preterm labor in a previous pregnancy. As recommended by the CDC, you need oral antibiotics immediately if there is any GBS in the urine. Be sure to also get IV antibiotics in labor, even if the labor stops and the u.t.i. is cleared.

8) A c-section DOES NOT automatically reduce the likelihood of infecting baby with GBS, but it increases mom's risk of post-birth infection.

Chances of GBS infection are a *slightly* lower for baby after a c-section, but 25% of babies who are born via c-section still have GBS on their skin, so c-section doesn't keep baby 100% safe from GBS. Also, mom is more likely to have complications from GBS after a c-section: GBS causes 50,000 maternal post-cesarean infections each year in the US. Just being a GBS carrier is not enough reason to have a c-section.

9) Talk with the pediatrician.

Advise him that you are GBS+ and talk about what this means for baby. Baby should be watched for a day or two to be sure all is well, but you should still be able to nurse, change diapers, room in, etc., if baby is well. A good site for information about the symptoms a sick baby exhibits is: < http://www.neonatology.org/syllabus/gbs.html>

10) Learn all you can. Informed parents are the best defense against GBS.

You are the only parents of your baby and it's your job to start protecting him NOW. If protecting him means standing up for what's best for you and baby, so be it.